Objective To examine the development of chemical and clinical vitamin B-12 deficiency after total gastrectomy, and to evaluate the efficacy of supplemental oral B-12 administration. Summary Background Data Postgastrectomy anemia is due to deficiencies of iron and vitamin B-12, and parenteral B-12 administration is the only appropriate treatment, However, no guidelines exist for the prophylactic use of B-12 in patients who undergo total gastrectomy, the clinical presentation of B-12 deficiency in this context has not been defined, and the question of whether oral B-12 administration can be used to prevent and treat B-12 deficiency has not been examined. Methods Serum B-12 concentrations were measured in 31 patients who had undergone total gastrectomy. Symptoms related to B-12 deficiency were surveyed in detail. Serum B-12 concentrations were measured every 6 months after total gastrectomy in 10 patients. Thirty one patients received supplemental B-12: 18 patients orally and 13 by intramuscular injection. Results The B-12 concentration dropped below the lower limit of normal (200 pg/mL) for the first time in two patients at 1 year, in four patients at 2 years, in three patients at 3 years, and in one patient at 4 years. Seventy-eight percent of patients reported some symptoms related to B-12 deficiency. The serum B-12 concentration in patients who received supplemental B-12 orally increased rapidly and all symptoms resolved with oral therapy alone. Conclusions B-12 deficiency can develop as early as 1 year after total gastrectomy and causes symptoms. Because enteral B-12 treatment increases the serum B-12 concentration and leads to rapid resolution of symptoms, it should be prescribed routinely to patients undergoing total gastrectomy.
